Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.38
R. Dovnar, A. Vasil'kov, T. M. Sakalova, I. Butenko, S. M. Smotryn, N. N. Iaskevich
Objective. To determine the minimum inhibitory concentration of Ag nanoparticles in relation to clinical pathogenic strains of microorganisms. Methods. The minimum inhibitory concentration of Ag nanoparticles, obtained by metal vapor synthesis was studied on six strains of pathogenic bacteria, including representatives of gram-positive and gram-negative groups. The microbiological analyzer Vitek 2 Compact was used to identify each strain and to determine the antibiogram. The metal nanoparticles used in the study were synthesized by the method of metalvapor synthesis. Ag nanoparticles were studied by transmission electron microscopy(TEM) and X-ray photoelectron spectroscopy (XPS) methods. Determination of the minimum inhibitory concentration was performed by the method of serial dilution using sterile 96-well plates with using the tests of positive and negative control. The concentration of microorganisms was controlled by the turbidity standard. Results. All pathogenic strains of bacteria used in the study were characterized by pronounced polyantibiotic resistance, and the percentage of antibiotics against which the strain was resistant ranged from 12.5 to 93.3%. The minimum inhibitory concentration of silver nanoparticles ranged from 7.81 to 31.25 μg/ml, depending on the type of microorganism. Gram-positive microorganisms, in contrast to gram-negative ones, were characterized by lower values of the minimum inhibitory concentration. The data of transmission electron and X-ray photoelectron spectroscopy showed that the size of the studied nanoparticles is in the range of 2-15 nm. Conclusion. Silver nanoparticles (2-15 nm in size) have antimicrobial action against clinically significant, polyantibiotic-resistant strains of microorganisms. The minimum inhibitory concentration of silver nanoparticles, depending on the strain of the microorganism, varies from 7.81 to 31.25 μg/ml. Silver nanoparticles have an inhibitory impact on microorganisms and to a greater extent inhibit the growth of gram-positive versus gram-negative. The obtained materials based on silver nanoparticles represent an effective alternative to the currently used antibacterial drugs. What this paper adds The quantitative indices of the antibacterial action of silver nanoparticles have been firstly studied on pathogenic polyantibioticresistant strains of microorganisms The impact of the antibacterial resistance of bacteria does not affect the degree of antimicrobial action of these nanoparticles has been demonstrated Determination of the minimum inhibitory concentration of silver nanoparticles is considered to be a significant step in the development of a scientifically based method of using this class of substances in surgery
{"title":"ANTIBACTERIAL ACTION OF SILVER NANOPARTICLES","authors":"R. Dovnar, A. Vasil'kov, T. M. Sakalova, I. Butenko, S. M. Smotryn, N. N. Iaskevich","doi":"10.18484/2305-0047.2022.1.38","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.38","url":null,"abstract":"Objective. To determine the minimum inhibitory concentration of Ag nanoparticles in relation to clinical pathogenic strains of microorganisms. Methods. The minimum inhibitory concentration of Ag nanoparticles, obtained by metal vapor synthesis was studied on six strains of pathogenic bacteria, including representatives of gram-positive and gram-negative groups. The microbiological analyzer Vitek 2 Compact was used to identify each strain and to determine the antibiogram. The metal nanoparticles used in the study were synthesized by the method of metalvapor synthesis. Ag nanoparticles were studied by transmission electron microscopy(TEM) and X-ray photoelectron spectroscopy (XPS) methods. Determination of the minimum inhibitory concentration was performed by the method of serial dilution using sterile 96-well plates with using the tests of positive and negative control. The concentration of microorganisms was controlled by the turbidity standard. Results. All pathogenic strains of bacteria used in the study were characterized by pronounced polyantibiotic resistance, and the percentage of antibiotics against which the strain was resistant ranged from 12.5 to 93.3%. The minimum inhibitory concentration of silver nanoparticles ranged from 7.81 to 31.25 μg/ml, depending on the type of microorganism. Gram-positive microorganisms, in contrast to gram-negative ones, were characterized by lower values of the minimum inhibitory concentration. The data of transmission electron and X-ray photoelectron spectroscopy showed that the size of the studied nanoparticles is in the range of 2-15 nm. Conclusion. Silver nanoparticles (2-15 nm in size) have antimicrobial action against clinically significant, polyantibiotic-resistant strains of microorganisms. The minimum inhibitory concentration of silver nanoparticles, depending on the strain of the microorganism, varies from 7.81 to 31.25 μg/ml. Silver nanoparticles have an inhibitory impact on microorganisms and to a greater extent inhibit the growth of gram-positive versus gram-negative. The obtained materials based on silver nanoparticles represent an effective alternative to the currently used antibacterial drugs. What this paper adds The quantitative indices of the antibacterial action of silver nanoparticles have been firstly studied on pathogenic polyantibioticresistant strains of microorganisms The impact of the antibacterial resistance of bacteria does not affect the degree of antimicrobial action of these nanoparticles has been demonstrated Determination of the minimum inhibitory concentration of silver nanoparticles is considered to be a significant step in the development of a scientifically based method of using this class of substances in surgery","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41750867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.12
R. Kalinin, I. Suchkov, N. Mzhavanadze, V. Povarov, E. Klimentova, O. Zhurina, G. Puchkova
Objective. To study the role of hemostatic parameters as potential markers of restenosis in patients with peripheral artery disease (PAD) after endovascular procedures. Methods. An open prospective study involved 55 PAD patients aged 63 (57; 69) with the stage IIb-IV Fontaine chronic lower limb ischemia; 48 (87.3%) subjects were male; 18 (32.73%) patients had type 2 diabetes mellitus (T2D). Before angioplasty or stenting of the arteries of the lower extremities, the activity of protein C (PrC), the levels of soluble endothelial receptors for protein C (sEPCR), the activity of coagulation factors FVIII, FIX, FXI were determined in the peripheral blood. Within a year every three months Duplex ultrasound or angiography for follow-up examination have been performed to detect restenosis. Results. Within one year restenosis was detected in 13 (23.6%) patients. Binary regression analysis revealed T2D, FVIII activity and sEPCR as prognostic markers of restenosis. sEPCR level lower than 46.8 ng/ml was associated with a 4.263 higher risk for restenosis after endovascular procedures (odds ratio 4.263, CI 95% 1.509-12.042); absolute risk 47±11% (CI 95% 25-69 %). The patients with T2D had a 2.6 higher risk for restenosis as compared to subjects without diabetes mellitus (odds ratio 2.6, CI 95% 1.031-6.599); absolute risk 41.18±12% (CI 95% 17.78-64.58%). The probability of developing restenosis was inversely related to the initial indicators of FVIII activity and the level of sEPCR: the lower the absolute values of FVIII and sEPCR, the higher the likelihood of developing restenosis in the postoperative period. Conclusion. Patientswith diabetes mellitus (type 2), reduced activity of coagulation factor FVIII and level of soluble endothelial protein C receptors are at particularlyhigh riskforrestenosis What this paper adds The study of hemostasis parameters in patients with the peripheral atherosclerosis revealed that the sEPCR level below 46.8 ng/ml corresponded to an elevateion of restenosis risk after endovascular interventions by 4.263 folds (odds ratio 4.263, 95% CI 1.509-12.042), the presence of type 2 diabetes mellitus - in 2.6 folds (odds ratio 2.6, 95% CI 1.031-6.599). The likelihood of developing restenosis was inversely related to baseline FVIII activity and sEPCR levels. The authors proposed a method for calculating the individual probability of developing restenosis using the abovementional indicators.
{"title":"PROGNOSTIC MARKERS OF RESTENOSIS IN PATIENTS WITH PERIPHERAL ARTERY DISEASE AFTER ENDOVASCULAR PROCEDURES","authors":"R. Kalinin, I. Suchkov, N. Mzhavanadze, V. Povarov, E. Klimentova, O. Zhurina, G. Puchkova","doi":"10.18484/2305-0047.2022.1.12","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.12","url":null,"abstract":"Objective. To study the role of hemostatic parameters as potential markers of restenosis in patients with peripheral artery disease (PAD) after endovascular procedures. Methods. An open prospective study involved 55 PAD patients aged 63 (57; 69) with the stage IIb-IV Fontaine chronic lower limb ischemia; 48 (87.3%) subjects were male; 18 (32.73%) patients had type 2 diabetes mellitus (T2D). Before angioplasty or stenting of the arteries of the lower extremities, the activity of protein C (PrC), the levels of soluble endothelial receptors for protein C (sEPCR), the activity of coagulation factors FVIII, FIX, FXI were determined in the peripheral blood. Within a year every three months Duplex ultrasound or angiography for follow-up examination have been performed to detect restenosis. Results. Within one year restenosis was detected in 13 (23.6%) patients. Binary regression analysis revealed T2D, FVIII activity and sEPCR as prognostic markers of restenosis. sEPCR level lower than 46.8 ng/ml was associated with a 4.263 higher risk for restenosis after endovascular procedures (odds ratio 4.263, CI 95% 1.509-12.042); absolute risk 47±11% (CI 95% 25-69 %). The patients with T2D had a 2.6 higher risk for restenosis as compared to subjects without diabetes mellitus (odds ratio 2.6, CI 95% 1.031-6.599); absolute risk 41.18±12% (CI 95% 17.78-64.58%). The probability of developing restenosis was inversely related to the initial indicators of FVIII activity and the level of sEPCR: the lower the absolute values of FVIII and sEPCR, the higher the likelihood of developing restenosis in the postoperative period. Conclusion. Patientswith diabetes mellitus (type 2), reduced activity of coagulation factor FVIII and level of soluble endothelial protein C receptors are at particularlyhigh riskforrestenosis What this paper adds The study of hemostasis parameters in patients with the peripheral atherosclerosis revealed that the sEPCR level below 46.8 ng/ml corresponded to an elevateion of restenosis risk after endovascular interventions by 4.263 folds (odds ratio 4.263, 95% CI 1.509-12.042), the presence of type 2 diabetes mellitus - in 2.6 folds (odds ratio 2.6, 95% CI 1.031-6.599). The likelihood of developing restenosis was inversely related to baseline FVIII activity and sEPCR levels. The authors proposed a method for calculating the individual probability of developing restenosis using the abovementional indicators.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46288182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.54
A. Murzich, O. Sokolovsky, O. Eismont, Y. Isaykina
Objective. To study the results of pre-differentiated MSCs application in the treatment of femoral head necrosis in young patients. Methods. The developed high-tech approach included: exfusion of 50-70 ml of patient’s bone marrow 4 weeks prior to implantation; osteogenic differentiation and obtaining a biomedical cell product; surgical decompression and introduction of pre-differentiated MSCs in fibrin gel; postoperative rehabilitation. Surgeries were performed in 25 patients at stages I and II according to the ARCO classification. The average age of patients is 34 [29; 45], men - 20 (80%), women - 5 (20%). Theassessment scaleis avisual analogue scale (VAS), Harris scale, radiography, MRI. Results. Observation period was 41 [19; 59] month. Average Harris score before surgery was 76 [68.8; 79] points, after treatment - 90 [78.9; 92] points. In 15 (60%) cases an excellent results were obtained, in 5 (20%) - good, in 3 (12%) - satisfactory, in 2 (8%) - unsatisfactory (collapse progression). The level of pain syndrome was reduced from 40 [30; 50] to 10 [5; 25] points. There were no complications. Preservation of the femoral head sphericity and the width of the joint space, relief of bone marrow edema, reduction of the necrosis zone size and synovitis according to MRI data were found in 92% of cases. Conclusion. The treatment method of femoral head necrosis with the use of pre-differentiated MSCs in the absence of infectious triggers in the lesion focus made it possible to preserve 95 % of cultured cells in the cell product composition and to introduce it minimally invasively, avoiding the need for bone graft collection. The introduction of the cellular technologies in practice made it possible to obtain positive treatment results in 92% of cases due to an improvement clinical condition by the Harris scale and reduce of pain syndrome compared to the initial state; it did not lead to infectious, allergic or other complications within the 41 [19; 59] month follow-up. What this paper adds A method of cell therapy of femoral head necrosis affected young patients using pre-differentiated mesenchymal stem cells (MSCs) has been firstly developed. The use of a new method of treatment made it possible to obtain positive results and preserve the structures of the hip joints in 92% of cases due to the optimization of the osteoregeneration process has been demonstrated.
{"title":"SURGICAL TREATMENT OF FEMORAL HEAD NECROSIS WITH PRE-DIFFERENTIATED MESENCHYMAL STEM CELLS","authors":"A. Murzich, O. Sokolovsky, O. Eismont, Y. Isaykina","doi":"10.18484/2305-0047.2022.1.54","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.54","url":null,"abstract":"Objective. To study the results of pre-differentiated MSCs application in the treatment of femoral head necrosis in young patients. Methods. The developed high-tech approach included: exfusion of 50-70 ml of patient’s bone marrow 4 weeks prior to implantation; osteogenic differentiation and obtaining a biomedical cell product; surgical decompression and introduction of pre-differentiated MSCs in fibrin gel; postoperative rehabilitation. Surgeries were performed in 25 patients at stages I and II according to the ARCO classification. The average age of patients is 34 [29; 45], men - 20 (80%), women - 5 (20%). Theassessment scaleis avisual analogue scale (VAS), Harris scale, radiography, MRI. Results. Observation period was 41 [19; 59] month. Average Harris score before surgery was 76 [68.8; 79] points, after treatment - 90 [78.9; 92] points. In 15 (60%) cases an excellent results were obtained, in 5 (20%) - good, in 3 (12%) - satisfactory, in 2 (8%) - unsatisfactory (collapse progression). The level of pain syndrome was reduced from 40 [30; 50] to 10 [5; 25] points. There were no complications. Preservation of the femoral head sphericity and the width of the joint space, relief of bone marrow edema, reduction of the necrosis zone size and synovitis according to MRI data were found in 92% of cases. Conclusion. The treatment method of femoral head necrosis with the use of pre-differentiated MSCs in the absence of infectious triggers in the lesion focus made it possible to preserve 95 % of cultured cells in the cell product composition and to introduce it minimally invasively, avoiding the need for bone graft collection. The introduction of the cellular technologies in practice made it possible to obtain positive treatment results in 92% of cases due to an improvement clinical condition by the Harris scale and reduce of pain syndrome compared to the initial state; it did not lead to infectious, allergic or other complications within the 41 [19; 59] month follow-up. What this paper adds A method of cell therapy of femoral head necrosis affected young patients using pre-differentiated mesenchymal stem cells (MSCs) has been firstly developed. The use of a new method of treatment made it possible to obtain positive results and preserve the structures of the hip joints in 92% of cases due to the optimization of the osteoregeneration process has been demonstrated.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46011357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.61
V. Ziamko, V. Okulich, A. Dzyadzko
Objective. To study dynamics of structure and antibiotic resistance of microflora in the intensive care unit depending on the amount of used antibiotics. Methods. 41375 isolates were studied in the intensive care unit of a multidisciplinary hospital from 2015 to early 2021. Bacteriological examination of clinical samples on basis of Republican Scientific and Practical Center “Infection in Surgery” has been performed. The primary treatment of results with the analysis of sensitivity of microorganisms to antibiotics was carried out by means of International Computer Program (WHONET). Antibiotic sensitivity was determined by disk-diffusion method, suspended in Mueller-Hinton broth and semi-automatic analyzer ATB Expression (BioMerieux, France). The analysis of consumption of antibacterial drugs in the intensive care unit was carried out according to data of pharmacy which operates at the medical institution where the research itself was carried out. Results. From 2015 to 2017 the analysis of microflora composition permitted to establish the prevalence of P. aeruginosa (22,74%), Acinetobacter spp. (22,25%) and K. pneumoniae (16,11%) which occurred 1,6 folds more often than other microorganisms while in general structure of multidisciplinary hospital S. aureus was most common (20,96% and 20,05%). Since 2018 carbapenem-resistant K. pneumonia has dominated (23,01%). Tigecycline and colistat were not effective against 4,3% and 5,7% of K. pneumoniae isolates in 2019, 10,2% and 13,7% of isolates in 2020, 37,3% and 39,6% - from January to May 2021 which was associated with a growth of tigecycline and colistat consumption. Conclusion. Since 2018 prevalence of carbapenem-resistant K. pneumoniae has been observed in microflora of the intensive care unit which is associated with a growth of consumption of antibacterial drugs which caused appearance of K. pneumoniae isolates resistant to colistin and tigecycline. What this paper adds The relation tendency between the consumed antibacterial agents and the growth of resistance to them in the intensive care intensive care unit of a multidisciplinary institution has been firstly analyzed. The predominance of carbapenem-resistant isolates of K. pneumoniae was established starting from 2018 which led to an increase in the use of tigecycline and colistin in the treatment of patients in the intensive care unit accompanied by the appearance of isolates resistant to them at the end of 2020.
{"title":"STRUCTURE OF MICROFLORA AND ANTIBIOTIC RESISTANCE TRENDS IN INTENSIVE CARE UNIT OF A MULTIDISCIPLINE INSTITUTION","authors":"V. Ziamko, V. Okulich, A. Dzyadzko","doi":"10.18484/2305-0047.2022.1.61","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.61","url":null,"abstract":"Objective. To study dynamics of structure and antibiotic resistance of microflora in the intensive care unit depending on the amount of used antibiotics. Methods. 41375 isolates were studied in the intensive care unit of a multidisciplinary hospital from 2015 to early 2021. Bacteriological examination of clinical samples on basis of Republican Scientific and Practical Center “Infection in Surgery” has been performed. The primary treatment of results with the analysis of sensitivity of microorganisms to antibiotics was carried out by means of International Computer Program (WHONET). Antibiotic sensitivity was determined by disk-diffusion method, suspended in Mueller-Hinton broth and semi-automatic analyzer ATB Expression (BioMerieux, France). The analysis of consumption of antibacterial drugs in the intensive care unit was carried out according to data of pharmacy which operates at the medical institution where the research itself was carried out. Results. From 2015 to 2017 the analysis of microflora composition permitted to establish the prevalence of P. aeruginosa (22,74%), Acinetobacter spp. (22,25%) and K. pneumoniae (16,11%) which occurred 1,6 folds more often than other microorganisms while in general structure of multidisciplinary hospital S. aureus was most common (20,96% and 20,05%). Since 2018 carbapenem-resistant K. pneumonia has dominated (23,01%). Tigecycline and colistat were not effective against 4,3% and 5,7% of K. pneumoniae isolates in 2019, 10,2% and 13,7% of isolates in 2020, 37,3% and 39,6% - from January to May 2021 which was associated with a growth of tigecycline and colistat consumption. Conclusion. Since 2018 prevalence of carbapenem-resistant K. pneumoniae has been observed in microflora of the intensive care unit which is associated with a growth of consumption of antibacterial drugs which caused appearance of K. pneumoniae isolates resistant to colistin and tigecycline. What this paper adds The relation tendency between the consumed antibacterial agents and the growth of resistance to them in the intensive care intensive care unit of a multidisciplinary institution has been firstly analyzed. The predominance of carbapenem-resistant isolates of K. pneumoniae was established starting from 2018 which led to an increase in the use of tigecycline and colistin in the treatment of patients in the intensive care unit accompanied by the appearance of isolates resistant to them at the end of 2020.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44291136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.74
S. S. Maskin, V. V. Aleksandrov, V. Matyukhin, L. Igolkina
Objective. Optimization of treatment and diagnostic tactics for blunt injury of the pancreas, gall bladder and extrahepatic bile ducts. Methods. This current review was undertaken by Russian and foreign literature (2015-2020 yrs) search according to the following themes: pancreatic injury, traumatic pancreatitis, gall bladder injury, extrahepatic bile ducts injury, damage control surgery tactics, blunt abdominal trauma, therapeutic and diagnostic algorithm, conservative (non-operative) management, with subsequent exception from the request of experimental studies and cases of open trauma in the Internation scientific datebase PubMed, Cochrane Library, Scopus, Embase, ScienceDirect, Google Scholar Search, eLibrary. Multicenter studies, systematic reviews, meta-analyses, large case series, original articles, and randomized controlled trials were analyzed, indicating the levels of evidence and effectiveness of recommendations. An original algorithmfor thediagnosis and management is proposed, the concept of damage control is described, and indications for diagnostic methods, conservative treatment, and types of surgical, endovascular, and minimally invasive interventions are specified depending on the severity of organ injury according to the classification of the American Association of the Surgery of Trauma (AAST) (table). Results. The algorithmfor thediagnosis and management for combined blunt trauma of the pancreas, gallbladder, and extrahepatic bile ducts is standardized, and indications for minimally invasive and open interventions in this category of patients are clarified. Conclusion. Accurate knowledge of the algorithm for the diagnosis and management, indications for endovascular, minimally invasive techniques and open interventions, the choice of tactics based on the patient’s condition, the time of the injury, and possible complications can improve the results of treatment.
{"title":"BLUNT INJURY OF PANCREAS, GALL BLADDER AND EXTRAHEPATIC BILE DUCTS: TACTICS BASED ON THE PRINCIPLES OF EVIDENCE-BASED MEDICINE","authors":"S. S. Maskin, V. V. Aleksandrov, V. Matyukhin, L. Igolkina","doi":"10.18484/2305-0047.2022.1.74","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.74","url":null,"abstract":"Objective. Optimization of treatment and diagnostic tactics for blunt injury of the pancreas, gall bladder and extrahepatic bile ducts. Methods. This current review was undertaken by Russian and foreign literature (2015-2020 yrs) search according to the following themes: pancreatic injury, traumatic pancreatitis, gall bladder injury, extrahepatic bile ducts injury, damage control surgery tactics, blunt abdominal trauma, therapeutic and diagnostic algorithm, conservative (non-operative) management, with subsequent exception from the request of experimental studies and cases of open trauma in the Internation scientific datebase PubMed, Cochrane Library, Scopus, Embase, ScienceDirect, Google Scholar Search, eLibrary. Multicenter studies, systematic reviews, meta-analyses, large case series, original articles, and randomized controlled trials were analyzed, indicating the levels of evidence and effectiveness of recommendations. An original algorithmfor thediagnosis and management is proposed, the concept of damage control is described, and indications for diagnostic methods, conservative treatment, and types of surgical, endovascular, and minimally invasive interventions are specified depending on the severity of organ injury according to the classification of the American Association of the Surgery of Trauma (AAST) (table). Results. The algorithmfor thediagnosis and management for combined blunt trauma of the pancreas, gallbladder, and extrahepatic bile ducts is standardized, and indications for minimally invasive and open interventions in this category of patients are clarified. Conclusion. Accurate knowledge of the algorithm for the diagnosis and management, indications for endovascular, minimally invasive techniques and open interventions, the choice of tactics based on the patient’s condition, the time of the injury, and possible complications can improve the results of treatment.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44924405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.112
M. Medvedchikov-Ardiia, E. Korymasov, A. Benyan
The case report of a patient with post-sternotomy mediastinitis is presented. A successful case of treatment of such a formidable complication after cardiac surgery was demonstrated. Success in the treatment of such patients depends on the complete cupping inflammatory process in the site of operation, as well as chest wall reconstruction. The positive clinical effect of vacuum-assisted dressings in the treatment of post-sternotomy mediastinitis is shown. The vertical rectus abdominis myocutaneous flap was used as a plastic material to cover a defect in the chest wall. The course of surgery and the result of treatment are described in details. To date, the surgical society has not developed a generally accepted tactic in the treatment of poststernotomy mediastinitis, both at the stage of arresting the infectious process, and in the process of reconstructive and restorative intervention. In practice, along with alloplastic materials, synthetic and metal implants are used. The autologous tissues include muscle flaps and the greater omentum. In thoracic surgery, the rectus abdominis can serve as an alternative to omentoplasty for extended chest wall defects.
{"title":"VERTICAL RECTUS ABDOMINIS MUSCLE FLAP FOR REPAIR OF THE ANTERIOR CHEST WALL DEFECT","authors":"M. Medvedchikov-Ardiia, E. Korymasov, A. Benyan","doi":"10.18484/2305-0047.2022.1.112","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.112","url":null,"abstract":"The case report of a patient with post-sternotomy mediastinitis is presented. A successful case of treatment of such a formidable complication after cardiac surgery was demonstrated. Success in the treatment of such patients depends on the complete cupping inflammatory process in the site of operation, as well as chest wall reconstruction. The positive clinical effect of vacuum-assisted dressings in the treatment of post-sternotomy mediastinitis is shown. The vertical rectus abdominis myocutaneous flap was used as a plastic material to cover a defect in the chest wall. The course of surgery and the result of treatment are described in details. To date, the surgical society has not developed a generally accepted tactic in the treatment of poststernotomy mediastinitis, both at the stage of arresting the infectious process, and in the process of reconstructive and restorative intervention. In practice, along with alloplastic materials, synthetic and metal implants are used. The autologous tissues include muscle flaps and the greater omentum. In thoracic surgery, the rectus abdominis can serve as an alternative to omentoplasty for extended chest wall defects.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44189742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.46
R. Nakonechnyy, A. Nakonechnyi
Objectives. To develop optimal postoperative wound care tactics for boys with hypospadias. Methods. The patients (128) with hypospadias aged from 11 months to 7 years were examined. The main group A consisted of 83 (64.8%) patients in whom we used a special bandage. It includes layer by layer of soft polyamide net two-sided onlay coated with soft silicone and adhesive properties, abundantly treated with an antimicrobial ointment containing an osmotic agent, sterile absorbent wipes with non-woven material, a circularly applied elastic bandage and an adhesive plaster with porous non-woven material. The dressing usually held up to 5 days. Group B included 45 (35.2%) patients with hypospadias, in whom we used a conventional sterile circular gauze bandage with antimicrobial ointment. The gauze bandage changed daily. For all clinical symptoms the groups were comparable in age. Postoperative wound healing had been monitored for 10 days after urethroplasty. The emphasis was made on such criteria as bleeding with hematoma formation, copious exudate excretion, penis skin hyperemia, «soft» and «dense» edema, drying crust (scab), skin sutures dehiscence, hypergranulation and necrosis. Results. In group A, problems with the skin flap and postoperative wound were detected only in 17 (20.5%) boys on the second or third day after removal of the special bandage. In the postoperative period, 41 (91.1%) patients in group B had «painful» skin changes in the area of the postoperative wound, which appeared almost the next day after surgery. Conclusion. The use of special bandage delays in time the contact of microbiota penis tissues compromised by surgery and the external environment, which, no doubt, improves the healing of skin grafts in the early postoperative period, and therefore reduces the number of urethroplasty complications. What this paper adds For the first time in patients with hypospadias, the process of postoperative wound healing was analyzed depending on the type of dressing. It was established that the use of a long-term bandage with a soft polyamide mesh doublesided pad with a silicone contact layer and adhesive properties compared to a traditional gauze bandage, which was changed daily, optimized the tactics of postoperative wound care in boys with hypospadias and minimized the number of urethroplasty complications.
{"title":"OPTIMIZATION OF SURGICAL WOUND CARE AFTER URETHROPLASTY IN CHILDREN WITH HYPOSPADIA","authors":"R. Nakonechnyy, A. Nakonechnyi","doi":"10.18484/2305-0047.2022.1.46","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.46","url":null,"abstract":"Objectives. To develop optimal postoperative wound care tactics for boys with hypospadias. Methods. The patients (128) with hypospadias aged from 11 months to 7 years were examined. The main group A consisted of 83 (64.8%) patients in whom we used a special bandage. It includes layer by layer of soft polyamide net two-sided onlay coated with soft silicone and adhesive properties, abundantly treated with an antimicrobial ointment containing an osmotic agent, sterile absorbent wipes with non-woven material, a circularly applied elastic bandage and an adhesive plaster with porous non-woven material. The dressing usually held up to 5 days. Group B included 45 (35.2%) patients with hypospadias, in whom we used a conventional sterile circular gauze bandage with antimicrobial ointment. The gauze bandage changed daily. For all clinical symptoms the groups were comparable in age. Postoperative wound healing had been monitored for 10 days after urethroplasty. The emphasis was made on such criteria as bleeding with hematoma formation, copious exudate excretion, penis skin hyperemia, «soft» and «dense» edema, drying crust (scab), skin sutures dehiscence, hypergranulation and necrosis. Results. In group A, problems with the skin flap and postoperative wound were detected only in 17 (20.5%) boys on the second or third day after removal of the special bandage. In the postoperative period, 41 (91.1%) patients in group B had «painful» skin changes in the area of the postoperative wound, which appeared almost the next day after surgery. Conclusion. The use of special bandage delays in time the contact of microbiota penis tissues compromised by surgery and the external environment, which, no doubt, improves the healing of skin grafts in the early postoperative period, and therefore reduces the number of urethroplasty complications. What this paper adds For the first time in patients with hypospadias, the process of postoperative wound healing was analyzed depending on the type of dressing. It was established that the use of a long-term bandage with a soft polyamide mesh doublesided pad with a silicone contact layer and adhesive properties compared to a traditional gauze bandage, which was changed daily, optimized the tactics of postoperative wound care in boys with hypospadias and minimized the number of urethroplasty complications.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48679423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.102
K. Lipatov, A. Asatryan, G. Melkonyan, V. Kuznetsov, I. V. Gorbacheva, M.V. Yurchenko
Objective. To study the treatment results of patients with necrotizing fasciitis (NF) of the upper limb. Methods. The authors’ observations of 9 patients with a rare and severe disease: necrotizing fasciitis (NF) of the upper limb have been analyzed. Minor skin lesions in the area of the hand became the entry gate for any infection. The median time prior hospitalization was 4,8±1,8 (M±σ) days. Immediately upon admission, the diagnosis of upper limb NF was established in 5 patients. This was followed by emergency radical surgery. The rest were also urgently operated on, but with a diagnosis of phlegmon of the hand and in insufficient volume. They were diagnosed with NF within the first day and a second operation was performed. In most cases the lesion included tissues of the hand, forearm, and arm. Primary surgery was supplemented by staged necrectomies, the number of which averaged 4,7±1,9 per patient. The complex of intensive treatment included broad-spectrum antibiotics, anticoagulants (enoxaparin 8,000 anti-Xa IU / day). Surgical closure of postnecrectomic wounds was performed using skin plastic operations: plastics with local tissues, autodermoplasty with a split graft. Results. Most of the cases were classified as type II NF (Streptococcus pyogenes or Staphylococcus aureus). In one case, a very rare and extremely severe, NF caused by Pasteurella multocida was observed. No antibiotic-resistant strains were found. Emergency radical operation became the cornerstone of success. The need for staged necrectomy was determined by the formation of secondary necrosis in connection with severe microcirculation disorders. Extensive postnecrectomic wounds were closed after the inflammation subsided with the help of skin plastic operations. The average duration of inpatient treatment was 20,8±6,2 days. There were no lethal outcomes. Conclusion. A complex approach to the treatment of necrotising fasciitis of upper limb allowed getting positive treatment results in all cases.
目标。探讨上肢坏死性筋膜炎(NF)的治疗效果。方法。作者对9例罕见严重疾病:上肢坏死性筋膜炎(NF)的观察结果进行了分析。手部区域的轻微皮肤病变成为任何感染的入口。入院前中位时间为4,8±1,8 (M±σ) d。5例患者入院后立即诊断为上肢NF。随后进行了紧急根治性手术。其余的人也接受了紧急手术，但诊断为手部痰多，痰量不足。他们在第一天被诊断为NF，并进行了第二次手术。在大多数病例中，病变包括手、前臂和手臂组织。初级手术辅以分期切除，平均每例4,7±1,9例。综合强化治疗包括广谱抗生素、抗凝血药物(依诺肝素8000抗xa IU /天)。切除后伤口的外科闭合采用皮肤整形手术:局部组织整形，自体真皮成形术和分裂移植物。结果。大多数病例为II型NF(化脓性链球菌或金黄色葡萄球菌)。在一例中，观察到由多杀性巴氏杆菌引起的非常罕见和极其严重的NF。未发现耐药菌株。紧急根治性手术成为成功的基石。需要分期切除坏死是由继发性坏死的形成与严重的微循环障碍。在皮肤整形手术的帮助下，大面积的切除后伤口在炎症消退后闭合。平均住院时间20.8±6.2 d。没有致命的结果。结论。一个复杂的方法来治疗上肢坏死性筋膜炎允许得到积极的治疗结果在所有情况下。
{"title":"NECROTISING FASCIITIS OF UPPER LIMB: CLINIC, DIAGNOSIS, TREATMENT","authors":"K. Lipatov, A. Asatryan, G. Melkonyan, V. Kuznetsov, I. V. Gorbacheva, M.V. Yurchenko","doi":"10.18484/2305-0047.2022.1.102","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.102","url":null,"abstract":"Objective. To study the treatment results of patients with necrotizing fasciitis (NF) of the upper limb. Methods. The authors’ observations of 9 patients with a rare and severe disease: necrotizing fasciitis (NF) of the upper limb have been analyzed. Minor skin lesions in the area of the hand became the entry gate for any infection. The median time prior hospitalization was 4,8±1,8 (M±σ) days. Immediately upon admission, the diagnosis of upper limb NF was established in 5 patients. This was followed by emergency radical surgery. The rest were also urgently operated on, but with a diagnosis of phlegmon of the hand and in insufficient volume. They were diagnosed with NF within the first day and a second operation was performed. In most cases the lesion included tissues of the hand, forearm, and arm. Primary surgery was supplemented by staged necrectomies, the number of which averaged 4,7±1,9 per patient. The complex of intensive treatment included broad-spectrum antibiotics, anticoagulants (enoxaparin 8,000 anti-Xa IU / day). Surgical closure of postnecrectomic wounds was performed using skin plastic operations: plastics with local tissues, autodermoplasty with a split graft. Results. Most of the cases were classified as type II NF (Streptococcus pyogenes or Staphylococcus aureus). In one case, a very rare and extremely severe, NF caused by Pasteurella multocida was observed. No antibiotic-resistant strains were found. Emergency radical operation became the cornerstone of success. The need for staged necrectomy was determined by the formation of secondary necrosis in connection with severe microcirculation disorders. Extensive postnecrectomic wounds were closed after the inflammation subsided with the help of skin plastic operations. The average duration of inpatient treatment was 20,8±6,2 days. There were no lethal outcomes. Conclusion. A complex approach to the treatment of necrotising fasciitis of upper limb allowed getting positive treatment results in all cases.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48014926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.119
V.Ya. Khryschchanovich, N. Skobeleva
Thrombophlebitis of the subcutaneous veins of the lower extremities, also called superficial thrombophlebitis (ST), is a well-known and common disease often occurring in pregnant women with varicose veins (VV). As a rule, ST is considered as a disease with an uncomplicated and mild course, which is usually not life-threatening. However, in the case of appearance of concomitant deep vein thrombosis and/or pulmonary embolism, ST can cause severe complications. The article presents a clinical case of treatment of a pregnant woman (28 weeks of gestational age) with acute ascending varicothrombophlebitis in the system of the great saphenous vein (GSV). According to ultrasound data, the patient was found to have insufficiency of the sapheno-femoral junction and occlusive thrombosis of the lateral branches and the trunk of GSV, extending to the middle third of the left thigh. Taking into account the obstetric history, clinical and ultrasound picture of the disease, and the risk of perioperative complications, it was decided to prescribe prolonged anticoagulation with low-molecular-weight heparin(LMWH) and perform phlebocentesis of thrombosed GSV segments. The basic component of symptomatic treatment of ST was elastic compression. The chosen option for managing gestational varicotrombophlebitis allowed improving the patient’s overall health, as well as to quickly (within 2-3 days) arrest local inflammation and significantly reduce local edema and pain. The case presented highlights the possibility of successful and safe use of needle aspiration thrombectomy and anticoagulation with LMWH in pregnant women with ascending subcutaneous venous thrombosis.
{"title":"PRINCIPLES OF ACUTE VARICOTHROMBOPHLEBITIS MANAGEMENT DURING PREGNANCY","authors":"V.Ya. Khryschchanovich, N. Skobeleva","doi":"10.18484/2305-0047.2022.1.119","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.119","url":null,"abstract":"Thrombophlebitis of the subcutaneous veins of the lower extremities, also called superficial thrombophlebitis (ST), is a well-known and common disease often occurring in pregnant women with varicose veins (VV). As a rule, ST is considered as a disease with an uncomplicated and mild course, which is usually not life-threatening. However, in the case of appearance of concomitant deep vein thrombosis and/or pulmonary embolism, ST can cause severe complications. The article presents a clinical case of treatment of a pregnant woman (28 weeks of gestational age) with acute ascending varicothrombophlebitis in the system of the great saphenous vein (GSV). According to ultrasound data, the patient was found to have insufficiency of the sapheno-femoral junction and occlusive thrombosis of the lateral branches and the trunk of GSV, extending to the middle third of the left thigh. Taking into account the obstetric history, clinical and ultrasound picture of the disease, and the risk of perioperative complications, it was decided to prescribe prolonged anticoagulation with low-molecular-weight heparin(LMWH) and perform phlebocentesis of thrombosed GSV segments. The basic component of symptomatic treatment of ST was elastic compression. The chosen option for managing gestational varicotrombophlebitis allowed improving the patient’s overall health, as well as to quickly (within 2-3 days) arrest local inflammation and significantly reduce local edema and pain. The case presented highlights the possibility of successful and safe use of needle aspiration thrombectomy and anticoagulation with LMWH in pregnant women with ascending subcutaneous venous thrombosis.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49397184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.18484/2305-0047.2022.1.86
E. Aghayev, Z. Ismayilova, T. Mamedov
The failure of intestinal anastomotic suture is one of the urgent and dangerous problems in abdominal surgery. This problem not only complicates the course of the early postoperative period and increases financial costs, but it is also the main cause of deaths, the rate of which remains quite high with generalized peritonitis. The problem of the intestinal anastomotic leakage in the postoperative period forces researchers to develop various methods of preoperative preparation of patients, ways to strengthen the line of stitched ends of the intestine, new protocols for managing patients in the postoperative period. Despite the use of atraumatic and minimally invasive techniques as well as various stapling devices, and biopolymers of various compositions, the morbidity rate for ananastomotic leak remains quite high. The literature analysis demonstrates a tendency of preservation high rates of the suture failure of intestinal anastomosis. The actuality of this problem is especially clearly observed in case of emergency and urgent resection of the intestine against the background of acute intestinal obstruction, cancer intoxication and generalized peritonitis. The risk of anastomotic failure is believed to be caused by the age and general condition of a patient, the nature of the underlying disease, the presence of concomitant chronic diseases, the type of surgical operation, as well as the method and localization of the anastomosis being created. Despite the fact that there are a lot of sources devoted to the analysis of the causes of this problem, there is no consensus on the significance of risk factors and the effectiveness of the preventive methods used. In a number of publications there are contradictory data concerning the effectiveness of some preventive methods. Therefore, the solution of this problem requires new fundamental researches.
{"title":"PREVENTION OF SUTURE INSUFFICIENCY IN INTESTINAL ANASTOMOSES","authors":"E. Aghayev, Z. Ismayilova, T. Mamedov","doi":"10.18484/2305-0047.2022.1.86","DOIUrl":"https://doi.org/10.18484/2305-0047.2022.1.86","url":null,"abstract":"The failure of intestinal anastomotic suture is one of the urgent and dangerous problems in abdominal surgery. This problem not only complicates the course of the early postoperative period and increases financial costs, but it is also the main cause of deaths, the rate of which remains quite high with generalized peritonitis. The problem of the intestinal anastomotic leakage in the postoperative period forces researchers to develop various methods of preoperative preparation of patients, ways to strengthen the line of stitched ends of the intestine, new protocols for managing patients in the postoperative period. Despite the use of atraumatic and minimally invasive techniques as well as various stapling devices, and biopolymers of various compositions, the morbidity rate for ananastomotic leak remains quite high. The literature analysis demonstrates a tendency of preservation high rates of the suture failure of intestinal anastomosis. The actuality of this problem is especially clearly observed in case of emergency and urgent resection of the intestine against the background of acute intestinal obstruction, cancer intoxication and generalized peritonitis. The risk of anastomotic failure is believed to be caused by the age and general condition of a patient, the nature of the underlying disease, the presence of concomitant chronic diseases, the type of surgical operation, as well as the method and localization of the anastomosis being created. Despite the fact that there are a lot of sources devoted to the analysis of the causes of this problem, there is no consensus on the significance of risk factors and the effectiveness of the preventive methods used. In a number of publications there are contradictory data concerning the effectiveness of some preventive methods. Therefore, the solution of this problem requires new fundamental researches.","PeriodicalId":38373,"journal":{"name":"Novosti Khirurgii","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43636426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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